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Emerging neural reconstruction techniques based on tomography (e.g., NeRF, NeAT, and NeRP) have started showing unique capabilities in medical imaging. In this work, we present a novel Polychromatic neural representation (Polyner) to tackle the challenging problem of CT imaging when metallic implants exist within the human body. The artifacts arise from the drastic variation of metal's attenuation coefficients at various energy levels of the X-ray spectrum, leading to a nonlinear metal effect in CT measurements. Reconstructing CT images from metal-affected measurements hence poses a complicated nonlinear inverse problem where empirical models adopted in previous metal artifact reduction (MAR) approaches lead to signal loss and strongly aliased reconstructions. Polyner instead models the MAR problem from a nonlinear inverse problem perspective. Specifically, we first derive a polychromatic forward model to accurately simulate the nonlinear CT acquisition process. Then, we incorporate our forward model into the implicit neural representation to accomplish reconstruction. Lastly, we adopt a regularizer to preserve the physical properties of the CT images across different energy levels while effectively constraining the solution space. Our Polyner is an unsupervised method and does not require any external training data. Experimenting with multiple datasets shows that our Polyner achieves comparable or better performance than supervised methods on in-domain datasets while demonstrating significant performance improvements on out-of-domain datasets. To the best of our knowledge, our Polyner is the first unsupervised MAR method that outperforms its supervised counterparts., Comment: 19 pages

The augmentation parameters matter to few-shot semantic segmentation since they directly affect the training outcome by feeding the networks with varying perturbated samples. However, searching optimal augmentation parameters for few-shot segmentation models without annotations is a challenge that current methods fail to address. In this paper, we first propose a framework to determine the ``optimal'' parameters without human annotations by solving a distribution-matching problem between the intra-instance and intra-class similarity distribution, with the intra-instance similarity describing the similarity between the original sample of a particular anatomy and its augmented ones and the intra-class similarity representing the similarity between the selected sample and the others in the same class. Extensive experiments demonstrate the superiority of our optimized augmentation in boosting few-shot segmentation models. We greatly improve the top competing method by 1.27\% and 1.11\% on Abd-MRI and Abd-CT datasets, respectively, and even achieve a significant improvement for SSL-ALP on the left kidney by 3.39\% on the Abd-CT dataset.

Undersampled MRI reconstruction is crucial for accelerating clinical scanning procedures. Recent deep learning methods for MRI reconstruction adopt CNN or ViT as backbone, which lack in utilizing the complementary properties of CNN and ViT. In this paper, we propose DuDoRNeXt, whose backbone hybridizes CNN and ViT in an domain-specific, intra-stage way. Besides our hybrid vertical layout design, we introduce domain-specific modules for dual-domain reconstruction, namely image-domain parallel local detail enhancement and k-space global initialization. We evaluate different conventions of MRI reconstruction including image-domain, k-space-domain, and dual-domain reconstruction with a reference protocol on the IXI dataset and an in-house multi-contrast dataset. DuDoRNeXt achieves significant improvements over competing deep learning methods.

Self-supervised learning is well known for its remarkable performance in representation learning and various downstream computer vision tasks. Recently, Positive-pair-Only Contrastive Learning (POCL) has achieved reliable performance without the need to construct positive-negative training sets. It reduces memory requirements by lessening the dependency on the batch size. The POCL method typically uses a single loss function to extract the distortion invariant representation (DIR) which describes the proximity of positive-pair representations affected by different distortions. This loss function implicitly enables the model to filter out or ignore the distortion variant representation (DVR) affected by different distortions. However, existing POCL methods do not explicitly enforce the disentanglement and exploitation of the actually valuable DVR. In addition, these POCL methods have been observed to be sensitive to augmentation strategies. To address these limitations, we propose a novel POCL framework named Distortion-Disentangled Contrastive Learning (DDCL) and a Distortion-Disentangled Loss (DDL). Our approach is the first to explicitly disentangle and exploit the DVR inside the model and feature stream to improve the overall representation utilization efficiency, robustness and representation ability. Experiments carried out demonstrate the superiority of our framework to Barlow Twins and Simsiam in terms of convergence, representation quality, and robustness on several benchmark datasets.

Clinical decision making requires counterfactual reasoning based on a factual medical image and thus necessitates causal image synthesis. To this end, we present a novel method for modeling the causality between demographic variables, clinical indices and brain MR images for Alzheimer's Diseases. Specifically, we leverage a structural causal model to depict the causality and a styled generator to synthesize the image. Furthermore, as a crucial step to reduce modeling complexity and make learning tractable, we propose the use of low dimensional latent feature representation of a high-dimensional 3D image, together with exogenous noise, to build causal relationship between the image and non image variables. We experiment the proposed method based on 1586 subjects and 3683 3D images and synthesize counterfactual brain MR images intervened on certain attributes, such as age, brain volume and cognitive test score. Quantitative metrics and qualitative evaluation of counterfactual images demonstrates the superiority of our generated images., Comment: 11 pages

One-shot medical landmark detection gains much attention and achieves great success for its label-efficient training process. However, existing one-shot learning methods are highly specialized in a single domain and suffer domain preference heavily in the situation of multi-domain unlabeled data. Moreover, one-shot learning is not robust that it faces performance drop when annotating a sub-optimal image. To tackle these issues, we resort to developing a domain-adaptive one-shot landmark detection framework for handling multi-domain medical images, named Universal One-shot Detection (UOD). UOD consists of two stages and two corresponding universal models which are designed as combinations of domain-specific modules and domain-shared modules. In the first stage, a domain-adaptive convolution model is self-supervised learned to generate pseudo landmark labels. In the second stage, we design a domain-adaptive transformer to eliminate domain preference and build the global context for multi-domain data. Even though only one annotated sample from each domain is available for training, the domain-shared modules help UOD aggregate all one-shot samples to detect more robust and accurate landmarks. We investigated both qualitatively and quantitatively the proposed UOD on three widely-used public X-ray datasets in different anatomical domains (i.e., head, hand, chest) and obtained state-of-the-art performances in each domain. The code is available at https://github.com/heqin-zhu/UOD_universal_oneshot_detection., Comment: Eealy accepted by MICCAI 2023. 11pages, 4 figures, 2 tables. arXiv admin note: text overlap with arXiv:2203.06433

Radiologists have different training and clinical experiences, which may result in various segmentation annotations for lung nodules, causing segmentation uncertainty. Conventional methods usually select a single annotation as the learning target or try to learn a latent space of various annotations, but these approaches waste the valuable information of consensus or disagreements ingrained in the multiple annotations. In this paper, we propose an Uncertainty-Aware Attention Mechanism (UAAM) that utilizes consensus and disagreements among multiple annotations to facilitate better segmentation. To achieve this, we introduce the Multi-Confidence Mask (MCM), which is a combination of a Low-Confidence (LC) Mask and a High-Confidence (HC) Mask. The LC mask indicates regions with a low segmentation confidence, which may cause different segmentation options among radiologists. Following UAAM, we further design an Uncertainty-Guide Segmentation Network (UGS-Net), which contains three modules: a Feature Extracting Module that captures a general feature of a lung nodule, an Uncertainty-Aware Module that produces three features for the annotations' union, intersection, and annotation set, and an Intersection-Union Constraining Module that uses distances between the three features to balance the predictions of final segmentation, LC mask, and HC mask. To fully demonstrate the performance of our method, we propose a Complex Nodule Validation on LIDC-IDRI, which tests UGS-Net's segmentation performance on lung nodules that are difficult to segment using U-Net. Experimental results demonstrate that our method can significantly improve the segmentation performance on nodules with poor segmentation by U-Net., Comment: 10 pages, 10 figures. We have reported a preliminary version of this work in MICCAI 2022

Domain shift and label scarcity heavily limit deep learning applications to various medical image analysis tasks. Unsupervised domain adaptation (UDA) techniques have recently achieved promising cross-modality medical image segmentation by transferring knowledge from a label-rich source domain to an unlabeled target domain. However, it is also difficult to collect annotations from the source domain in many clinical applications, rendering most prior works suboptimal with the label-scarce source domain, particularly for few-shot scenarios, where only a few source labels are accessible. To achieve efficient few-shot cross-modality segmentation, we propose a novel transformation-consistent meta-hallucination framework, meta-hallucinator, with the goal of learning to diversify data distributions and generate useful examples for enhancing cross-modality performance. In our framework, hallucination and segmentation models are jointly trained with the gradient-based meta-learning strategy to synthesize examples that lead to good segmentation performance on the target domain. To further facilitate data hallucination and cross-domain knowledge transfer, we develop a self-ensembling model with a hallucination-consistent property. Our meta-hallucinator can seamlessly collaborate with the meta-segmenter for learning to hallucinate with mutual benefits from a combined view of meta-learning and self-ensembling learning. Extensive studies on MM-WHS 2017 dataset for cross-modality cardiac segmentation demonstrate that our method performs favorably against various approaches by a lot in the few-shot UDA scenario., Comment: Accepted by MICCAI 2022 (top 13% paper; early accept)

Deep neural networks have been widely studied for predicting a medical condition, such as total knee replacement (TKR). It has shown that data of different modalities, such as imaging data, clinical variables and demographic information, provide complementary information and thus can improve the prediction accuracy together. However, the data sources of various modalities may not always be of high quality, and each modality may have only partial information of medical condition. Thus, predictions from different modalities can be opposite, and the final prediction may fail in the presence of such a conflict. Therefore, it is important to consider the reliability of each source data and the prediction output when making a final decision. In this paper, we propose an evidence-aware multi-modal data fusion framework based on the Dempster-Shafer theory (DST). The backbone models contain an image branch, a non-image branch and a fusion branch. For each branch, there is an evidence network that takes the extracted features as input and outputs an evidence score, which is designed to represent the reliability of the output from the current branch. The output probabilities along with the evidence scores from multiple branches are combined with the Dempster's combination rule to make a final prediction. Experimental results on the public OA initiative (OAI) dataset for the TKR prediction task show the superiority of the proposed fusion strategy on various backbone models.

Deep learning is becoming increasingly ubiquitous in medical research and applications while involving sensitive information and even critical diagnosis decisions. Researchers observe a significant performance disparity among subgroups with different demographic attributes, which is called model unfairness, and put lots of effort into carefully designing elegant architectures to address unfairness, which poses heavy training burden, brings poor generalization, and reveals the trade-off between model performance and fairness. To tackle these issues, we propose FairAdaBN by making batch normalization adaptive to sensitive attribute. This simple but effective design can be adopted to several classification backbones that are originally unaware of fairness. Additionally, we derive a novel loss function that restrains statistical parity between subgroups on mini-batches, encouraging the model to converge with considerable fairness. In order to evaluate the trade-off between model performance and fairness, we propose a new metric, named Fairness-Accuracy Trade-off Efficiency (FATE), to compute normalized fairness improvement over accuracy drop. Experiments on two dermatological datasets show that our proposed method outperforms other methods on fairness criteria and FATE., Comment: Accepted by MICCAI 2023

Artificial Intelligence (AI) is having a tremendous impact across most areas of science. Applications of AI in healthcare have the potential to improve our ability to detect, diagnose, prognose, and intervene on human disease. For AI models to be used clinically, they need to be made safe, reproducible and robust, and the underlying software framework must be aware of the particularities (e.g. geometry, physiology, physics) of medical data being processed. This work introduces MONAI, a freely available, community-supported, and consortium-led PyTorch-based framework for deep learning in healthcare. MONAI extends PyTorch to support medical data, with a particular focus on imaging, and provide purpose-specific AI model architectures, transformations and utilities that streamline the development and deployment of medical AI models. MONAI follows best practices for software-development, providing an easy-to-use, robust, well-documented, and well-tested software framework. MONAI preserves the simple, additive, and compositional approach of its underlying PyTorch libraries. MONAI is being used by and receiving contributions from research, clinical and industrial teams from around the world, who are pursuing applications spanning nearly every aspect of healthcare., Comment: www.monai.io

Magnetic Resonance (MR) image reconstruction from under-sampled acquisition promises faster scanning time. To this end, current State-of-The-Art (SoTA) approaches leverage deep neural networks and supervised training to learn a recovery model. While these approaches achieve impressive performances, the learned model can be fragile on unseen degradation, e.g. when given a different acceleration factor. These methods are also generally deterministic and provide a single solution to an ill-posed problem; as such, it can be difficult for practitioners to understand the reliability of the reconstruction. We introduce DiffuseRecon, a novel diffusion model-based MR reconstruction method. DiffuseRecon guides the generation process based on the observed signals and a pre-trained diffusion model, and does not require additional training on specific acceleration factors. DiffuseRecon is stochastic in nature and generates results from a distribution of fully-sampled MR images; as such, it allows us to explicitly visualize different potential reconstruction solutions. Lastly, DiffuseRecon proposes an accelerated, coarse-to-fine Monte-Carlo sampling scheme to approximate the most likely reconstruction candidate. The proposed DiffuseRecon achieves SoTA performances reconstructing from raw acquisition signals in fastMRI and SKM-TEA. Code will be open-sourced at www.github.com/cpeng93/DiffuseRecon.

Magnetic resonance (MR) images exhibit various contrasts and appearances based on factors such as different acquisition protocols, views, manufacturers, scanning parameters, etc. This generally accessible appearance-related side information affects deep learning-based undersampled magnetic resonance imaging (MRI) reconstruction frameworks, but has been overlooked in the majority of current works. In this paper, we investigate the use of such side information as normalisation parameters in a convolutional neural network (CNN) to improve undersampled MRI reconstruction. Specifically, a Side Information-Guided Normalisation (SIGN) module, containing only few layers, is proposed to efficiently encode the side information and output the normalisation parameters. We examine the effectiveness of such a module on two popular reconstruction architectures, D5C5 and OUCR. The experimental results on both brain and knee images under various acceleration rates demonstrate that the proposed method improves on its corresponding baseline architectures with a significant margin.

Accurate anatomical landmark detection plays an increasingly vital role in medical image analysis. Although existing methods achieve satisfying performance, they are mostly based on CNN and specialized for a single domain say associated with a particular anatomical region. In this work, we propose a universal model for multi-domain landmark detection by taking advantage of transformer for modeling long dependencies and develop a domain-adaptive transformer model, named as DATR, which is trained on multiple mixed datasets from different anatomies and capable of detecting landmarks of any image from those anatomies. The proposed DATR exhibits three primary features: (i) It is the first universal model which introduces transformer as an encoder for multi-anatomy landmark detection; (ii) We design a domain-adaptive transformer for anatomy-aware landmark detection, which can be effectively extended to any other transformer network; (iii) Following previous studies, we employ a light-weighted guidance network, which encourages the transformer network to detect more accurate landmarks. We carry out experiments on three widely used X-ray datasets for landmark detection, which have 1,588 images and 62 landmarks in total, including three different anatomies (head, hand, and chest). Experimental results demonstrate that our proposed DATR achieves state-of-the-art performances by most metrics and behaves much better than any previous convolution-based models. The code will be released publicly., Comment: 8 pages, 2 figures, 4 tables

Contrastive learning and self-supervised techniques have gained prevalence in computer vision for the past few years. It is essential for medical image analysis, which is often notorious for its lack of annotations. Most existing self-supervised methods applied in natural imaging tasks focus on designing proxy tasks for unlabeled data. For example, contrastive learning is often based on the fact that an image and its transformed version share the same identity. However, pixel annotations contain much valuable information for medical image segmentation, which is largely ignored in contrastive learning. In this work, we propose a novel pre-training framework called Mixed Contrastive Learning (MixCL) that leverages both image identities and pixel labels for better modeling by maintaining identity consistency, label consistency, and reconstruction consistency together. Consequently, thus pre-trained model has more robust representations that characterize medical images. Extensive experiments demonstrate the effectiveness of the proposed method, improving the baseline by 5.28% and 14.12% in Dice coefficient when 5% labeled data of Spleen and 15% of BTVC are used in fine-tuning, respectively.

Fast screening and diagnosis are critical in COVID-19 patient treatment. In addition to the gold standard RT-PCR, radiological imaging like X-ray and CT also works as an important means in patient screening and follow-up. However, due to the excessive number of patients, writing reports becomes a heavy burden for radiologists. To reduce the workload of radiologists, we propose DeltaNet to generate medical reports automatically. Different from typical image captioning approaches that generate reports with an encoder and a decoder, DeltaNet applies a conditional generation process. In particular, given a medical image, DeltaNet employs three steps to generate a report: 1) first retrieving related medical reports, i.e., the historical reports from the same or similar patients; 2) then comparing retrieved images and current image to find the differences; 3) finally generating a new report to accommodate identified differences based on the conditional report. We evaluate DeltaNet on a COVID-19 dataset, where DeltaNet outperforms state-of-the-art approaches. Besides COVID-19, the proposed DeltaNet can be applied to other diseases as well. We validate its generalization capabilities on the public IU-Xray and MIMIC-CXR datasets for chest-related diseases. Code is available at \url{https://github.com/LX-doctorAI1/DeltaNet}.

Accurate polyp segmentation is of great importance for colorectal cancer diagnosis and treatment. However, due to the high cost of producing accurate mask annotations, existing polyp segmentation methods suffer from severe data shortage and impaired model generalization. Reversely, coarse polyp bounding box annotations are more accessible. Thus, in this paper, we propose a boosted BoxPolyp model to make full use of both accurate mask and extra coarse box annotations. In practice, box annotations are applied to alleviate the over-fitting issue of previous polyp segmentation models, which generate fine-grained polyp area through the iterative boosted segmentation model. To achieve this goal, a fusion filter sampling (FFS) module is firstly proposed to generate pixel-wise pseudo labels from box annotations with less noise, leading to significant performance improvements. Besides, considering the appearance consistency of the same polyp, an image consistency (IC) loss is designed. Such IC loss explicitly narrows the distance between features extracted by two different networks, which improves the robustness of the model. Note that our BoxPolyp is a plug-and-play model, which can be merged into any appealing backbone. Quantitative and qualitative experimental results on five challenging benchmarks confirm that our proposed model outperforms previous state-of-the-art methods by a large margin., Comment: Accepted by MICCAI2022, Codes Available

Robotic-assisted surgery allows surgeons to conduct precise surgical operations with stereo vision and flexible motor control. However, the lack of 3D spatial perception limits situational awareness during procedures and hinders mastering surgical skills in the narrow abdominal space. Depth estimation, as a representative perception task, is typically defined as an image reconstruction problem. In this work, we show that depth estimation can be reformed from a 3D surface perspective. We propose a loss function for depth estimation that integrates the surface-aware constraints, leading to a faster and better convergence with the valid information from spatial information. In addition, camera parameters are incorporated into the training pipeline to increase the control and transparency of the depth estimation. We also integrate a specularity removal module to recover more buried image information. Quantitative experimental results on endoscopic datasets and user studies with medical professionals demonstrate the effectiveness of our method.

Automated salient object detection (SOD) plays an increasingly crucial role in many computer vision applications. By reformulating the depth information as supervision rather than as input, depth-supervised convolutional neural networks (CNN) have achieved promising results on both RGB and RGB-D SOD scenarios with the merits of no requirements for extra depth networks and depth inputs in the inference stage. This paper, for the first time, seeks to expand the applicability of depth supervision to the Transformer architecture. Specifically, we develop a Depth-supervised Fusion TRansformer (DFTR), to further improve the accuracy of both RGB and RGB-D SOD. The proposed DFTR involves three primary features: 1) DFTR, to the best of our knowledge, is the first pure Transformer-based model for depth-supervised SOD; 2) A multi-scale feature aggregation (MFA) module is proposed to fully exploit the multi-scale features encoded by the Swin Transformer in a coarse-to-fine manner; 3) To enable bidirectional information flow across different streams of features, a novel multi-stage feature fusion (MFF) module is further integrated into our DFTR with the emphasis on salient regions at different network learning stages. We extensively evaluate the proposed DFTR on ten benchmarking datasets. Experimental results show that our DFTR consistently outperforms the existing state-of-the-art methods for both RGB and RGB-D SOD tasks. The code and model will be made publicly available., Comment: 15 pages, 5 figures, 4 tables

In the paper, we present an approach for learning a single model that universally segments 33 anatomical structures, including vertebrae, pelvic bones, and abdominal organs. Our model building has to address the following challenges. Firstly, while it is ideal to learn such a model from a large-scale, fully-annotated dataset, it is practically hard to curate such a dataset. Thus, we resort to learn from a union of multiple datasets, with each dataset containing the images that are partially labeled. Secondly, along the line of partial labelling, we contribute an open-source, large-scale vertebra segmentation dataset for the benefit of spine analysis community, CTSpine1K, boasting over 1,000 3D volumes and over 11K annotated vertebrae. Thirdly, in a 3D medical image segmentation task, due to the limitation of GPU memory, we always train a model using cropped patches as inputs instead a whole 3D volume, which limits the amount of contextual information to be learned. To this, we propose a cross-patch transformer module to fuse more information in adjacent patches, which enlarges the aggregated receptive field for improved segmentation performance. This is especially important for segmenting, say, the elongated spine. Based on 7 partially labeled datasets that collectively contain about 2,800 3D volumes, we successfully learn such a universal model. Finally, we evaluate the universal model on multiple open-source datasets, proving that our model has a good generalization performance and can potentially serve as a solid foundation for downstream tasks.

Universal Lesion Detection (ULD) in computed tomography plays an essential role in computer-aided diagnosis. Promising ULD results have been reported by multi-slice-input detection approaches which model 3D context from multiple adjacent CT slices, but such methods still experience difficulty in obtaining a global representation among different slices and within each individual slice since they only use convolution-based fusion operations. In this paper, we propose a novel Slice Attention Transformer (SATr) block which can be easily plugged into convolution-based ULD backbones to form hybrid network structures. Such newly formed hybrid backbones can better model long-distance feature dependency via the cascaded self-attention modules in the Transformer block while still holding a strong power of modeling local features with the convolutional operations in the original backbone. Experiments with five state-of-the-art methods show that the proposed SATr block can provide an almost free boost to lesion detection accuracy without extra hyperparameters or special network designs., Comment: 11 pages, 3 figures

Medical image super-resolution (SR) is an active research area that has many potential applications, including reducing scan time, bettering visual understanding, increasing robustness in downstream tasks, etc. However, applying deep-learning-based SR approaches for clinical applications often encounters issues of domain inconsistency, as the test data may be acquired by different machines or on different organs. In this work, we present a novel algorithm called domain adaptable volumetric super-resolution (DA-VSR) to better bridge the domain inconsistency gap. DA-VSR uses a unified feature extraction backbone and a series of network heads to improve image quality over different planes. Furthermore, DA-VSR leverages the in-plane and through-plane resolution differences on the test data to achieve a self-learned domain adaptation. As such, DA-VSR combines the advantages of a strong feature generator learned through supervised training and the ability to tune to the idiosyncrasies of the test volumes through unsupervised learning. Through experiments, we demonstrate that DA-VSR significantly improves super-resolution quality across numerous datasets of different domains, thereby taking a further step toward real clinical applications., Comment: MICCAI2021

Contrastive learning based methods such as cascade comparing to detect (CC2D) have shown great potential for one-shot medical landmark detection. However, the important cue of relative distance between landmarks is ignored in CC2D. In this paper, we upgrade CC2D to version II by incorporating a simple-yet-effective relative distance bias in the training stage, which is theoretically proved to encourage the encoder to project the relatively distant landmarks to the embeddings with low similarities. As consequence, CC2Dv2 is less possible to detect a wrong point far from the correct landmark. Furthermore, we present an open-source, landmark-labeled dataset for the measurement of biomechanical parameters of the lower extremity to alleviate the burden of orthopedic surgeons. The effectiveness of CC2Dv2 is evaluated on the public dataset from the ISBI 2015 Grand-Challenge of cephalometric radiographs and our new dataset, which greatly outperforms the state-of-the-art one-shot landmark detection approaches.

It is a long-standing challenge to reconstruct Cone Beam Computed Tomography (CBCT) of the lung under respiratory motion. This work takes a step further to address a challenging setting in reconstructing a multi-phase}4D lung image from just a single}3D CBCT acquisition. To this end, we introduce REpiratory-GAted Synthesis of views, or REGAS. REGAS proposes a self-supervised method to synthesize the undersampled tomographic views and mitigate aliasing artifacts in reconstructed images. This method allows a much better estimation of between-phase Deformation Vector Fields (DVFs), which are used to enhance reconstruction quality from direct observations without synthesis. To address the large memory cost of deep neural networks on high resolution 4D data, REGAS introduces a novel Ray Path Transformation (RPT) that allows for distributed, differentiable forward projections. REGAS require no additional measurements like prior scans, air-flow volume, or breathing velocity. Our extensive experiments show that REGAS significantly outperforms comparable methods in quantitative metrics and visual quality.

Computed tomography (CT) is a widely-used imaging technology that assists clinical decision-making with high-quality human body representations. To reduce the radiation dose posed by CT, sparse-view and limited-angle CT are developed with preserved image quality. However, these methods are still stuck with a fixed or uniform sampling strategy, which inhibits the possibility of acquiring a better image with an even reduced dose. In this paper, we explore this possibility via learning an active sampling policy that optimizes the sampling positions for patient-specific, high-quality reconstruction. To this end, we design an \textit{intelligent agent} for active recommendation of sampling positions based on on-the-fly reconstruction with obtained sinograms in a progressive fashion. With such a design, we achieve better performances on the NIH-AAPM dataset over popular uniform sampling, especially when the number of views is small. Finally, such a design also enables RoI-aware reconstruction with improved reconstruction quality within regions of interest (RoI's) that are clinically important. Experiments on the VerSe dataset demonstrate this ability of our sampling policy, which is difficult to achieve based on uniform sampling.

Pseudo-normality synthesis, which computationally generates a pseudo-normal image from an abnormal one (e.g., with lesions), is critical in many perspectives, from lesion detection, data augmentation to clinical surgery suggestion. However, it is challenging to generate high-quality pseudo-normal images in the absence of the lesion information. Thus, expensive lesion segmentation data have been introduced to provide lesion information for the generative models and improve the quality of the synthetic images. In this paper, we aim to alleviate the need of a large amount of lesion segmentation data when generating pseudo-normal images. We propose a Semi-supervised Medical Image generative LEarning network (SMILE) which not only utilizes limited medical images with segmentation masks, but also leverages massive medical images without segmentation masks to generate realistic pseudo-normal images. Extensive experiments show that our model outperforms the best state-of-the-art model by up to 6% for data augmentation task and 3% in generating high-quality images. Moreover, the proposed semi-supervised learning achieves comparable medical image synthesis quality with supervised learning model, using only 50 of segmentation data.

Universal Lesion Detection (ULD) in computed tomography plays an essential role in computer-aided diagnosis. Promising ULD results have been reported by coarse-to-fine two-stage detection approaches, but such two-stage ULD methods still suffer from issues like imbalance of positive v.s. negative anchors during object proposal and insufficient supervision problem during localization regression and classification of the region of interest (RoI) proposals. While leveraging pseudo segmentation masks such as bounding map (BM) can reduce the above issues to some degree, it is still an open problem to effectively handle the diverse lesion shapes and sizes in ULD. In this paper, we propose a BM-based conditional training for two-stage ULD, which can (i) reduce positive vs. negative anchor imbalance via BM-based conditioning (BMC) mechanism for anchor sampling instead of traditional IoU-based rule; and (ii) adaptively compute size-adaptive BM (ABM) from lesion bounding box, which is used for improving lesion localization accuracy via ABMsupervised segmentation. Experiments with four state-of-the-art methods show that the proposed approach can bring an almost free detection accuracy improvement without requiring expensive lesion mask annotations.

Deep reinforcement learning (DRL) augments the reinforcement learning framework, which learns a sequence of actions that maximizes the expected reward, with the representative power of deep neural networks. Recent works have demonstrated the great potential of DRL in medicine and healthcare. This paper presents a literature review of DRL in medical imaging. We start with a comprehensive tutorial of DRL, including the latest model-free and model-based algorithms. We then cover existing DRL applications for medical imaging, which are roughly divided into three main categories: (I) parametric medical image analysis tasks including landmark detection, object/lesion detection, registration, and view plane localization; (ii) solving optimization tasks including hyperparameter tuning, selecting augmentation strategies, and neural architecture search; and (iii) miscellaneous applications including surgical gesture segmentation, personalized mobile health intervention, and computational model personalization. The paper concludes with discussions of future perspectives., 39 pages, 20 figures

Computed tomography (CT) reconstruction from X-ray projections acquired within a limited angle range is challenging, especially when the angle range is extremely small. Both analytical and iterative models need more projections for effective modeling. Deep learning methods have gained prevalence due to their excellent reconstruction performances, but such success is mainly limited within the same dataset and does not generalize across datasets with different distributions. Hereby we propose ExtraPolationNetwork for limited-angle CT reconstruction via the introduction of a sinogram extrapolation module, which is theoretically justified. The module complements extra sinogram information and boots model generalizability. Extensive experimental results show that our reconstruction model achieves state-of-the-art performance on NIH-AAPM dataset, similar to existing approaches. More importantly, we show that using such a sinogram extrapolation module significantly improves the generalization capability of the model on unseen datasets (e.g., COVID-19 and LIDC datasets) when compared to existing approaches.

There exists a large number of datasets for organ segmentation, which are partially annotated, and sequentially constructed. A typical dataset is constructed at a certain time by curating medical images and annotating the organs of interest. In other words, new datasets with annotations of new organ categories are built over time. To unleash the potential behind these partially labeled, sequentially-constructed datasets, we propose to learn a multi-organ segmentation model through incremental learning (IL). In each IL stage, we lose access to the previous annotations, whose knowledge is assumingly captured by the current model, and gain the access to a new dataset with annotations of new organ categories, from which we learn to update the organ segmentation model to include the new organs. We give the first attempt to conjecture that the different distribution is the key reason for 'catastrophic forgetting' that commonly exists in IL methods, and verify that IL has the natural adaptability to medical image scenarios. Extensive experiments on five open-sourced datasets are conducted to prove the effectiveness of our method and the conjecture mentioned above.

Metal artifact reduction (MAR) in computed tomography (CT) is a notoriously challenging task because the artifacts are structured and non-local in the image domain. However, they are inherently local in the sinogram domain. Thus, one possible approach to MAR is to exploit the latter characteristic by learning to reduce artifacts in the sinogram. However, if we directly treat the metal-affected regions in sinogram as missing and replace them with the surrogate data generated by a neural network, the artifact-reduced CT images tend to be over-smoothed and distorted since fine-grained details within the metal-affected regions are completely ignored. In this work, we provide analytical investigation to the issue and propose to address the problem by (1) retaining the metal-affected regions in sinogram and (2) replacing the binarized metal trace with the metal mask projection such that the geometry information of metal implants is encoded. Extensive experiments on simulated datasets and expert evaluations on clinical images demonstrate that our novel network yields anatomically more precise artifact-reduced images than the state-of-the-art approaches, especially when metallic objects are large., Comment: accepted by MICCAI 2020

Recent methods in multiple landmark detection based on deep convolutional neural networks (CNNs) reach high accuracy and improve traditional clinical workflow. However, the vulnerability of CNNs to adversarial-example attacks can be easily exploited to break classification and segmentation tasks. This paper is the first to study how fragile a CNN-based model on multiple landmark detection to adversarial perturbations. Specifically, we propose a novel Adaptive Targeted Iterative FGSM (ATI-FGSM) attack against the state-of-the-art models in multiple landmark detection. The attacker can use ATI-FGSM to precisely control the model predictions of arbitrarily selected landmarks, while keeping other stationary landmarks still, by adding imperceptible perturbations to the original image. A comprehensive evaluation on a public dataset for cephalometric landmark detection demonstrates that the adversarial examples generated by ATI-FGSM break the CNN-based network more effectively and efficiently, compared with the original Iterative FGSM attack. Our work reveals serious threats to patients' health. Furthermore, we discuss the limitations of our method and provide potential defense directions, by investigating the coupling effect of nearby landmarks, i.e., a major source of divergence in our experiments. Our source code is available at https://github.com/qsyao/attack_landmark_detection., Comment: accepted by MICCAI2020

Catheter segmentation in 3D ultrasound is important for computer-assisted cardiac intervention. However, a large amount of labeled images are required to train a successful deep convolutional neural network (CNN) to segment the catheter, which is expensive and time-consuming. In this paper, we propose a novel catheter segmentation approach, which requests fewer annotations than the supervised learning method, but nevertheless achieves better performance. Our scheme considers a deep Q learning as the pre-localization step, which avoids voxel-level annotation and which can efficiently localize the target catheter. With the detected catheter, patch-based Dual-UNet is applied to segment the catheter in 3D volumetric data. To train the Dual-UNet with limited labeled images and leverage information of unlabeled images, we propose a novel semi-supervised scheme, which exploits unlabeled images based on hybrid constraints from predictions. Experiments show the proposed scheme achieves a higher performance than state-of-the-art semi-supervised methods, while it demonstrates that our method is able to learn from large-scale unlabeled images.

With the mushrooming use of computed tomography (CT) images in clinical decision making, management of CT data becomes increasingly difficult. From the patient identification perspective, using the standard DICOM tag to track patient information is challenged by issues such as misspelling, lost file, site variation, etc. In this paper, we explore the feasibility of leveraging the faces in 3D CT images as biometric features. Specifically, we propose an automatic processing pipeline that first detects facial landmarks in 3D for ROI extraction and then generates aligned 2D depth images, which are used for automatic recognition. To boost the recognition performance, we employ transfer learning to reduce the data sparsity issue and to introduce a group sampling strategy to increase inter-class discrimination when training the recognition network. Our proposed method is capable of capturing underlying identity characteristics in medical images while reducing memory consumption. To test its effectiveness, we curate 600 3D CT images of 280 patients from multiple sources for performance evaluation. Experimental results demonstrate that our method achieves a 1:56 identification accuracy of 92.53% and a 1:1 verification accuracy of 96.12%, outperforming other competing approaches.

Clinical neuroimaging has recently witnessed explosive growth in data availability which brings studying heterogeneity in clinical cohorts to the spotlight. Normative modeling is an emerging statistical tool for achieving this objective. However, its application remains technically challenging due to difficulties in properly dealing with nuisance variation, for example due to variability in image acquisition devices. Here, in a fully probabilistic framework, we propose an application of hierarchical Bayesian regression (HBR) for multi-site normative modeling. Our experimental results confirm the superiority of HBR in deriving more accurate normative ranges on large multi-site neuroimaging data compared to widely used methods. This provides the possibility i) to learn the normative range of structural and functional brain measures on large multi-site data; ii) to recalibrate and reuse the learned model on local small data; therefore, HBR closes the technical loop for applying normative modeling as a medical tool for the diagnosis and prognosis of mental disorders.

The one-to-one mapping is necessary for many bidirectional image-to-image translation applications, such as MRI image synthesis as MRI images are unique to the patient. State-of-the-art approaches for image synthesis from domain X to domain Y learn a convolutional neural network that meticulously maps between the domains. A different network is typically implemented to map along the opposite direction, from Y to X. In this paper, we explore the possibility of only wielding one network for bi-directional image synthesis. In other words, such an autonomous learning network implements a self-inverse function. A self-inverse network shares several distinct advantages: only one network instead of two, better generalization and more restricted parameter space. Most importantly, a self-inverse function guarantees a one-to-one mapping, a property that cannot be guaranteed by earlier approaches that are not self-inverse. The experiments on three datasets show that, compared with the baseline approaches that use two separate models for the image synthesis along two directions, our self-inverse network achieves better synthesis results in terms of standard metrics. Finally, our sensitivity analysis confirms the feasibility of learning a self-inverse function for the bidirectional image translation., Comment: 10 pages, 9 figures

A conventional approach to computed tomography (CT) or cone beam CT (CBCT) metal artifact reduction is to replace the X-ray projection data within the metal trace with synthesized data. However, existing projection or sinogram completion methods cannot always produce anatomically consistent information to fill the metal trace, and thus, when the metallic implant is large, significant secondary artifacts are often introduced. In this work, we propose to replace metal artifact affected regions with anatomically consistent content through joint projection-sinogram correction as well as adversarial learning. To handle the metallic implants of diverse shapes and large sizes, we also propose a novel mask pyramid network that enforces the mask information across the network's encoding layers and a mask fusion loss that reduces early saturation of adversarial training. Our experimental results show that the proposed projection-sinogram correction designs are effective and our method recovers information from the metal traces better than the state-of-the-art methods., Comment: This paper is accepted to MICCAI 2019

Although chest X-ray (CXR) offers a 2D projection with overlapped anatomies, it is widely used for clinical diagnosis. There is clinical evidence supporting that decomposing an X-ray image into different components (e.g., bone, lung and soft tissue) improves diagnostic value. We hereby propose a decomposition generative adversarial network (DecGAN) to anatomically decompose a CXR image but with unpaired data. We leverage the anatomy knowledge embedded in CT, which features a 3D volume with clearly visible anatomies. Our key idea is to embed CT priori decomposition knowledge into the latent space of unpaired CXR autoencoder. Specifically, we train DecGAN with a decomposition loss, adversarial losses, cycle-consistency losses and a mask loss to guarantee that the decomposed results of the latent space preserve realistic body structures. Extensive experiments demonstrate that DecGAN provides superior unsupervised CXR bone suppression results and the feasibility of modulating CXR components by latent space disentanglement. Furthermore, we illustrate the diagnostic value of DecGAN and demonstrate that it outperforms the state-of-the-art approaches in terms of predicting 11 out of 14 common lung diseases., Comment: 9 pages with 4 figures

Simultaneous segmentation of multiple organs from different medical imaging modalities is a crucial task as it can be utilized for computer-aided diagnosis, computer-assisted surgery, and therapy planning. Thanks to the recent advances in deep learning, several deep neural networks for medical image segmentation have been introduced successfully for this purpose. In this paper, we focus on learning a deep multi-organ segmentation network that labels voxels. In particular, we examine the critical choice of a loss function in order to handle the notorious imbalance problem that plagues both the input and output of a learning model. The input imbalance refers to the class-imbalance in the input training samples (i.e., small foreground objects embedded in an abundance of background voxels, as well as organs of varying sizes). The output imbalance refers to the imbalance between the false positives and false negatives of the inference model. In order to tackle both types of imbalance during training and inference, we introduce a new curriculum learning based loss function. Specifically, we leverage Dice similarity coefficient to deter model parameters from being held at bad local minima and at the same time gradually learn better model parameters by penalizing for false positives/negatives using a cross entropy term. We evaluated the proposed loss function on three datasets: whole body positron emission tomography (PET) scans with 5 target organs, magnetic resonance imaging (MRI) prostate scans, and ultrasound echocardigraphy images with a single target organ i.e., left ventricular. We show that a simple network architecture with the proposed integrative loss function can outperform state-of-the-art methods and results of the competing methods can be improved when our proposed loss is used.

Automatic liver segmentation in 3D medical images is essential in many clinical applications, such as pathological diagnosis of hepatic diseases, surgical planning, and postoperative assessment. However, it is still a very challenging task due to the complex background, fuzzy boundary, and various appearance of liver. In this paper, we propose an automatic and efficient algorithm to segment liver from 3D CT volumes. A deep image-to-image network (DI2IN) is first deployed to generate the liver segmentation, employing a convolutional encoder-decoder architecture combined with multi-level feature concatenation and deep supervision. Then an adversarial network is utilized during training process to discriminate the output of DI2IN from ground truth, which further boosts the performance of DI2IN. The proposed method is trained on an annotated dataset of 1000 CT volumes with various different scanning protocols (e.g., contrast and non-contrast, various resolution and position) and large variations in populations (e.g., ages and pathology). Our approach outperforms the state-of-the-art solutions in terms of segmentation accuracy and computing efficiency., Comment: Accepted by MICCAI 2017

Automatic localization and labeling of vertebra in 3D medical images plays an important role in many clinical tasks, including pathological diagnosis, surgical planning and postoperative assessment. However, the unusual conditions of pathological cases, such as the abnormal spine curvature, bright visual imaging artifacts caused by metal implants, and the limited field of view, increase the difficulties of accurate localization. In this paper, we propose an automatic and fast algorithm to localize and label the vertebra centroids in 3D CT volumes. First, we deploy a deep image-to-image network (DI2IN) to initialize vertebra locations, employing the convolutional encoder-decoder architecture together with multi-level feature concatenation and deep supervision. Next, the centroid probability maps from DI2IN are iteratively evolved with the message passing schemes based on the mutual relation of vertebra centroids. Finally, the localization results are refined with sparsity regularization. The proposed method is evaluated on a public dataset of 302 spine CT volumes with various pathologies. Our method outperforms other state-of-the-art methods in terms of localization accuracy. The run time is around 3 seconds on average per case. To further boost the performance, we retrain the DI2IN on additional 1000+ 3D CT volumes from different patients. To the best of our knowledge, this is the first time more than 1000 3D CT volumes with expert annotation are adopted in experiments for the anatomic landmark detection tasks. Our experimental results show that training with such a large dataset significantly improves the performance and the overall identification rate, for the first time by our knowledge, reaches 90 %.

While deep convolutional neural networks (CNN) have been successfully applied for 2D image analysis, it is still challenging to apply them to 3D anisotropic volumes, especially when the within-slice resolution is much higher than the between-slice resolution and when the amount of 3D volumes is relatively small. On one hand, direct learning of CNN with 3D convolution kernels suffers from the lack of data and likely ends up with poor generalization; insufficient GPU memory limits the model size or representational power. On the other hand, applying 2D CNN with generalizable features to 2D slices ignores between-slice information. Coupling 2D network with LSTM to further handle the between-slice information is not optimal due to the difficulty in LSTM learning. To overcome the above challenges, we propose a 3D Anisotropic Hybrid Network (AH-Net) that transfers convolutional features learned from 2D images to 3D anisotropic volumes. Such a transfer inherits the desired strong generalization capability for within-slice information while naturally exploiting between-slice information for more effective modelling. The focal loss is further utilized for more effective end-to-end learning. We experiment with the proposed 3D AH-Net on two different medical image analysis tasks, namely lesion detection from a Digital Breast Tomosynthesis volume, and liver and liver tumor segmentation from a Computed Tomography volume and obtain the state-of-the-art results.